Eligibility generally includes the employee, spouse (or domestic partner), and eligible dependent children up to age 26. You or your provider may contact the Trust Fund Office, United Administrative Services, to confirm your eligibility status.
Enrollment forms and information for the medical plans you are eligible for are found on the Actives, Apprentices, or Retirees webpages.
Health and Welfare Plan Documents
Medical Plans
Anthem Blue Cross of California is offered to Actives, Early Retirees (age 55-64), and Apprentices.
Anthem Blue Cross is a PPO (Preferred Provider Organization) plan for health coverage for hospitalization, physician visits, medical procedures, and laboratory work. Pharmacy benefits are provided by SavRX, which offers steep discounts (30% off retail co-pay) for long-term medications. This plan is self-funded and administered by United Administrative Services (UAS). You will find your Explanation of Benefits (EOB) statements by logging into the portal at UAS Benefit Login. For more information, see the Anthem FAQs below.
Kaiser Permanente is offered to Actives and Early Retirees (age 55-64).
Kaiser is a health maintenance organization (HMO) plan that is only open to Actives and Early Retirees who are residents of the Northern California Kaiser Service Area; it is not available for for Participants residing outside of the area. Kaiser provides access to services such as routine care with your own personal Plan Physician, hospital care, laboratory, pharmacy, vision, chemical dependency, and many other benefits. You will receive most covered services at the Northern California Kaiser Plan Facilities. For more information, view the Kaiser Benefit Summary or request a Kaiser booklet at the UAS Office (408) 288-4433 or (800) 541-8059.
Medicare Supplemental Plans are offered to Retirees (age 65+):
- Retirees in Kaiser Service Area: Kaiser Senior Advantage (2019)
- Retirees in California: Blue Shield of CA Medicare Supplement (Part F)
- Retirees outside of California: Hartford Medicare Supplement (2016)
Our Plans
Anthem Blue Cross
Kaiser HMO
Group #8972
Our Plan Providers
Retail and Mail Order Prescriptions
Anthem Blue Cross, Blue Shield, and Hartford participants
(866) 233-IBEW
www.savrx.com
(408) 288-4400
Toll-Free: (800) 541-8059
(Refer to Group #277955M002.)
www.anthem.com/ca
Kaiser Permanente
1800 Harrison Street, 13th Floor
Oakland, CA 94120
(800) 464-4000 (English)
(800) 788-0616 (Spanish)
www.kaiserpermanente.org
Continuation Coverage
COBRA: A federal law known as the Consolidated Omnibus Budget Reconciliation Act of 1985 (“COBRA”), requires that group health plans offer covered Employees and their Dependents the opportunity to elect to pay a temporary extension of health coverage (called “Cobra Continuation Coverage” or “COBRA”) in certain instances (called “qualifying events”) where coverage under the Plan would otherwise end. To receive this continuation coverage the Employee, spouse and/or Dependent(s) must make timely monthly payments (including the stub payment form) directly to the Plan (or, the Bank Depository if so designated by the Plan Office).
Surviving Spouse: Upon the death of a covered active participant, a surviving spouse and Dependent child(ren), if any, shall continue to be eligible for benefits until the participant’s reserve hours are exhausted for fully subsidized continued coverage under the Plan. Once the reserve bank is exhausted, the surviving spouse and/or children will receive an additional six months of free coverage.
Claims Procedures
Your rights and protection against surprise medical bills: Click here for more information
The Claims and Appeals procedures in this section only apply to the Self-funded medical (Anthem Blue Cross), prescription drug benefits (SavRx), and mental health/substance use disorder (Optum United EAP). Otherwise, claims and appeals are governed by the rules of the providing companies. Copies of the applicable claims and appeals procedures are available from Kaiser and in the links provided on the Benefits page.
- Under the procedures set forth in the Plan and as is required by ERISA, if your claim for a health benefit is denied in whole or in part, you will receive a written explanation including the specific reasons for the denial.
- You will be notified in writing of such denial within 90 days after receipt of such application or claim (in most situations, much earlier than 90 days). An extension of time not exceeding 90 days may be required in special circumstances. In many situations, there are delays because of information required by the Plan Office to process an application (such as a birth certificate and/or marriage certificate).
- You then have the right to have the Board of Trustees review and reconsider your claim. If you have a question regarding the Plan or your benefit, you have the right to submit a letter to the Plan office seeking a response. The Plan will respond within a timely manner (within thirty days).
Anthem Blue Cross FAQs
Why did the Trust Fund elect to move to a self-funded program?
On an annual basis, the Board of Trustees evaluate the renewals received from our vendor partners to determine market competitiveness. This past renewal was unacceptable and the Board of Trustees decided to market the program. After reviewing all the opportunities, the Board of Trustees decided to move to a self-funded program which provides the Board of Trustees important financial data to ensure the long term viability of the Health & Welfare program.
What is the Prudent Buyer Network?
The Prudent Buyer Network is a Preferred Provider Organization (PPO) that is owned and operated by Anthem Blue Cross of California. The Prudent Buyer Network (PPO Providers) is an organization that operates under contract with the Administrator to provide hospital, medical and surgical services at agreed upon allowances. Prudent Buyer providers are located in California.
What allowances are provided by the Prudent Buyer Network (PPO)?
Prudent Buyer Allowances is the dollar amount allowed for each particular type of medical service by Prudent Buyer Providers. Prudent Buyer providers (PPO) have agreed to accept the allowance as full payment for service for Self Funded PPO Plan members, although they will often list a higher fee.
What is UCR?
Usual Customary and Reasonable (UCR) is a range of fees which are usually charged and received for the given treatment by doctors of similar training within the appropriate geographic area.
What is my “lifetime maximum” for benefits and what is meant by the plan will restore an additional $1,500 per year?
The lifetime maximum is the total “lifetime” amount of available benefits for you under the program. Each of your dependents have their own “lifetime” maximum. The restoration benefit is an amount of $1,500 per year which will be added back (restored) each year you are covered under the plan.
What is considered to be a routine physical?
On an annual basis, you may seek the services of your provider to conduct a routine physical. A routine physical is a periodic comprehensive preventive medicine reevaluation and management of an individual.
The eligible reimbursed expenses will vary depending on the age, gender, history, examination, risk factor reduction interventions and ordering of appropriate immunizations, laboratory/diagnostic procedures.
Please explain the value of using the prescription mail order program.
For 2 times the retail co-pay, you receive 3 times the medication by using the Mail Order Service available through SavRX. It is common to use these services for ongoing needed medications. Please contact SavRX directly at (866) 233-4239 for any questions regarding your prescription drug plan.
How are claims processed through the Prudent Buyer Network and then processed by our Administrator, United Administrative Services (UAS)?
Your Administrator, United Administrative Services (UAS), and Anthem Blue Cross of California (Prudent Buyer Network) jointly administer and process certain claims utilizing the Prudent Buyer Network (PPO) discounts. After seeking services through a Prudent Buyer (PPO) network, your provider will send all necessary paperwork to Prudent Buyer (PPO), who will in turn work with UAS to provide the specifics of reimbursement. UAS will process the claim and send an explanation of benefits on how the claim was processed.
What are the requirements to retire under the San Mateo Electrical Workers Health Plan?
- You must have been an active eligible Participant in the Health and Welfare Plan for ten (10) out of the last fifteen (15) years and two (2) out of the last five (5) years immediately preceding the date of retirement.
- You must be receiving or have recently applied for pension benefits from the San Mateo County Electrical Construction Industry Retirement Trust (IBEW Local 617).
- You must be an active eligible participant in the San Mateo Electrical Workers Health Plan as of your retirement date for Retiree Health and Welfare coverage.
- You must be at least 55 years of age and eligible to retire under the San Mateo County Electrical Construction Industry Retirement Trust.
- If you otherwise qualify for early or regular retirement (except for reaching age 55) because of a total and permanent disability as determined by the Social Security Administration at any age you will be eligible for retiree health and welfare benefits upon paying the required premium.
Please contact the Trust Fund office for more information.
I am thinking about retirement, where should I begin?
You should apply 90 days prior to your planned requested retirement date. Contact the Fund Office or the Union Office to obtain a retirement application. You must complete the application in full and provide all of the required documentation. Your requested retirement date can be no sooner than the first day of the third (3rd) month following the date the completed application is received by the Fund Office. Once the completed application is received by the Fund Office, it will be reviewed for completeness and your application will be sent to United Administrative Services (UAS). UAS will send you confirmation of your retirement date under the San Mateo Electrical Workers Health Plan. A denial letter will be sent if you do not qualify for the Retirement Plan.
What happens to the hours in my hour bank when I retire?
If you have hours remaining in your hour bank when you retire, the hour bank balance is converted to dollars by multiplying the hours left in your bank by the contribution rate in force at the time of retirement. That dollar amount is then sent by the San Mateo Electrical Workers Health Plan to UAS to be credited to your account. UAS is the administrator of the San Mateo Workers Retirement Trust. UAS will contact you directly with the coverage available and the cost of retirement plan coverage.
Please contact United Administrative Services directly at (408) 288-4400 should you have any questions on your claim. Anthem Blue Cross cannot answer questions about your specific claim.